| * This is how I prepared for CCS
sarra75 - 11/28/12 22:19
I think I did well in CCS because I had similar cases to UW . In the exam, when I read the H&P , I knew the cases and how to manage them step by step. When I start reviewing for the exam, I repeated the 50 cases 3 times and tried to do cases every day. After that, I start doing the 41 solved cases . I read the H&P and tried to do the case without reading explanation.
One week before my exam , I started doing 20 cases per day and repetition is KEY !!
When you start a case, pay attention to location and start thinking if you r going to transfer patient to ER or send home.
One case in my exam was about Asthma or COPD exacerbation . So I made sure to give patient necessary meds and wait for 4h to see if patient got better. I checked the PEF which was high and decided to discharge patient. ( if u admit patient bf 4h , and discharge him next day , you would loose points)
When u study , try to draw an algorithm for every case . Most of us know how to approach STEMI cases ( start with MONA, EKG, monitor……) because we follow the ACLS protocol. What if u have a patient with UC, what would u do? In the exam , u should not be thinking or guessing but knowing the next step immediately.
Premier review book helped me a lot in ccs. Like for the asthma case, I knew exactly what to and tried to recall all the step in management and classification of asthma.
For example , if patient s/p surgery and C/O SOB what would u do next? What r ur differentials? Atelactasis or PE or aspiration pneumonia?
If you supect a PE, what would u do next ?? FOBT not spiral CT
If an obese female presents with amenorrhea, what would u do? Most likely PCOS and u need to solve it step by step…. u need to r/o diabetes , hypothyroidism , get US…
Remember to admit patient with severe DUB, child abuse
If elderly with dementia and u suspect or u r sure it’s Alzheimer , do NOT start donepzil in the first visit. Order labs and send him home
By the way, if u have pt with HIV and fatigue or cough, please admit ☺
Also, be prepared for uncommon cases like MM , Hodgkin , ALL,CML, rape, carpel tunnel .
sarra75 - 11/28/12 23:13
check for chlamydia, gonorrhe
Hepatitic b and c
PREGNANCY TEST....IF NEGATIVE GIVE OCP
SOCIAL GROUP SUPPORT
TREAT INFECTION IF PRESENT
blocker - 11/29/12 00:13
great points and imprssive , i wish I can be ready like that some day before the exam
sarra75 - 11/29/12 01:46
IN THE SECOND DAY OF EXAM, WRITE THESE INFO BEFORE U START CCS SECTION.
ROUTINE LABS FOR ALL CASES
FATIGUE= ANEMIA, TSH, FOBT, DEPRESSION INDEX
AT THE END OF CASE ORDER :
LMWH OR COMPRESSION SOTCKING
CANCEL IV ACCESS
sarra75 - 11/29/12 03:46
A 6 month old baby with FTT. what r ur differential? could be abuse , malabsorption, lactose intolerance...
First do complete physical exam bc u have no idea of Dx and u have 10 mn to solve case.
Patient has systolic murmur....Now u can narrow ur DDX list to vsd.
So next get routine lab, echo....is this correct ?
No !! you should admit baby bc he is symptomatic=FTT
CXR shows infiltrates so start furosemide
ECHO shows VSD
cardio consult after echo
May need lisinopril
How would a patient with MM present and what r the clues that will make u think of MM?
Patient with lump in neck? is it begin or hodgkin? what would u do next?
Patient with polydipsia and polyuria. what labs do u order in this visit? Results come in a week and hgA1c >6.5; do u start metformin or special diet and exercise? Send patient home and see him in 2wk. if still symtomatic, start metformin. BUT make sure u check bun/creatine bc metformin cause acidosis. Do I need to give ACEI? order microalbuminuria , if positve start lisinopril ? Does he have hyperkalimia? you need to pay attention to every meds u order.
In my exam , i gave ACEI to patient with hyperkalemia :)
I learned all this info by practicing cases many times.
Practice as many cases as u can .